Measuring and improving the quality of mental health care: bringing patient-reported outcome et experience measures (PROMs et PREMs) in psychiatric settings

Introduction Patient-reported outcome and experience measures (PROMs and PREMs) are increasingly acknowledged as critical to enhancing patient-centred, value-based care. However, research is lacking on the function and relevance of these instruments in acute psychiatric care. Objectives The main objective of this study was to evaluate the domain of subjective well-being as a relevant indicator of the quality of hospital care, distinct from measures of symptom improvement and satisfaction with care reported by patients, assuming they only incompletely reflect inpatients’ unmet needs and expectations. [YA5] [SE6] We hypothesised that the patients’ measures of subjective well-being (generic PROMs) at discharge are only partially related to the satisfaction with the experience of care (PREMs), that in turn differs from the clinician’s experience of the provided care, and symptom improvement (disease-specific PROMs). Methods Two hundred and forty-eight inpatients of a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardised generic PROMs on well-being, symptom improvement was assessed using standardised disease-specific PROMs, and experience of care with PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of provided treatment using adapted PREMs items. Results Change in subjective well-being (PROMs) at discharge was significantly (p<.001), but moderately (r²=28.5%), correlated to improvement in symptom outcomes, and weakly correlated to the experience of care (PREMs) (r²=11.0%), the latter being weakly explained by symptom changes (r²=6.9%. Patients and clinicians assessed differently the experience of care. Conclusions Findings confirmed our hypothesis showing that across mental disorders improvement in subjective well-being was weakly correlated to the experience of care and moderately, negatively, correlated to symptom outcomes. Improvement in symptoms was found to be the strongest predictor of increase in subjective well-being at discharge, but it explained only a moderate part of its variance. In conclusion, this study shows that PROMs and PREMs have potential as key indicators of high quality care across mental health services, and supports the case for measuring subjective well-being as a relevant indicator in its own right, particularly in psychiatric hospital treatments. Patient-reported measures enable the implementation of patient-centred therapeutic management and the delivery of services focused on achieving outcomes that matter to patients across the full pathway of care. Disclosure of Interest None Declared

Introduction: Nurse presenteeism has long been of global concern, with impacts on nurse staffing levels, patient care, and hospital costs.
Objectives: This international study aimed to explore the factors associated with presenteeism among frontline nurses and nurse managers in acute, primary, and long-term healthcare settings in Portugal and Switzerland. Methods: A qualitative descriptive study involving online Focus Groups (FGs). The FGs included 55 participants and lasted 5 months (from March 2021 to July 2021). A purposive sampling strategy was used to select nurses. The inclusion criteria were as follows: (a) working in a public or private healthcare setting with at least one month of experience in their current workplace (which is officially considered the time required for integration); (b) working at least 20% of a full-time equivalent position; and (c) having a bachelor's, master's, or PhD degree. This study followed the COREQ checklist. Results: Participants included 55 nurses: 49 females and 6 males. Three main reasons for presenteeism were identified: unfamiliar terminology; the paradoxical effect of`being present' but absent; and presenteeism as a survival strategy. Six contributing factors were also recognized: (a) institutional disinterest toward employees; (b) paradigm shift: the tension between person-centered and task-centered care; (c) sudden changes in care practices due to the COVID-19 pandemic; (d) a lack of shared work perspectives with hierarchical superiors; (e) the financial burden of being absent from work; and (f) misfit of human responses (Laranjeira et al., 2022).
Conclusions: This study has generated in-depth knowledge about concepts and causes of presenteeism and has instructive for a broad audience of nurse managers and leaders. Our thematic analysis shows that presenteeism can be explained by factors related to the pressure to attend work, by individuals' constraints and commitment and by the organizational environment. Introduction: Patient-reported outcome and experience measures (PROMs and PREMs) are increasingly acknowledged as critical to enhancing patient-centred, value-based care. However, research is lacking on the function and relevance of these instruments in acute psychiatric care. Objectives: The main objective of this study was to evaluate the domain of subjective well-being as a relevant indicator of the quality of hospital care, distinct from measures of symptom improvement and satisfaction with care reported by patients, assuming they only incompletely reflect inpatients' unmet needs and expectations.
[YA5] [SE6] We hypothesised that the patients' measures of subjective wellbeing (generic PROMs) at discharge are only partially related to the satisfaction with the experience of care (PREMs), that in turn differs from the clinician's experience of the provided care, and symptom improvement (disease-specific PROMs). Methods: Two hundred and forty-eight inpatients of a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardised generic PROMs on well-being, symptom improvement was assessed using standardised disease-specific PROMs, and experience of care with PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of provided treatment using adapted PREMs items. Results: Change in subjective well-being (PROMs) at discharge was significantly (p<.001), but moderately (r²=28.5%), correlated to improvement in symptom outcomes, and weakly correlated to the experience of care (PREMs) (r²=11.0%), the latter being weakly explained by symptom changes (r²=6.9%. Patients and clinicians assessed differently the experience of care. Conclusions: Findings confirmed our hypothesis showing that across mental disorders improvement in subjective well-being was weakly correlated to the experience of care and moderately, negatively, correlated to symptom outcomes. Improvement in symptoms was found to be the strongest predictor of increase in subjective well-being at discharge, but it explained only a moderate part of its variance.
In conclusion, this study shows that PROMs and PREMs have potential as key indicators of high quality care across mental health services, and supports the case for measuring subjective well-being as a relevant indicator in its own right, particularly in psychiatric hospital treatments. Patient-reported measures enable the implementation of patient-centred therapeutic management and the delivery of services focused on achieving outcomes that matter to patients across the full pathway of care.

EPP0373
Caring for Bierzo: A plan for improving motivation for health workers from Mental Health Introduction: Motivation is an essential determinant of performance, particularly for those working in difficult conditions, such as the conditions facing many health workers. The relationship between motivation and performance is influenced by the health workers' organizational environment and social context. Many intrinsic and extrinsic factors may influence the impulse to head for and maintain and effort to achieve the objectives of the organization these may include acknowledgements, status and incentives, but also auto efficacy perception, personal growth, welfare and physical and mental health. In the last years and particularly during COVID-19 pandemic health organizations have suffered a crisis of lack of motivation and high turnover rates in health professional, particularly among highly specialized professions. Objectives: to develop a quality program to promote mental health and motivation, detect risk of mental disorders and improve communication skills in the health workers of the Health Area of El Bierzo (GASBI). Methods: A committee with four members form the psychiatry and mental health service, two from the Quality and Security Unit and 1 from the Occupational Risk Prevention Service analyzed the GASBI with a SWOT-CAME matrix analysis. Actions to be implemented were ordered with a Hanlon method score according to a representative sample of the employees of GASBI. Results: The CAME matrix recommended an offensive strategy, given a number of strengths and the opportunities for an administration sensible to new paradigms. The program proposed included 6 main lines (evaluation, access to mental health consultation, prevention of suicide behavior, resilience group, communication and relation groups and a group of actions to improve motivation and prevent burnout called "10 actions to dream together", displayed in figures 1 and 2. The Hanlon classified suicide behaviour as the highest priority (score: 16,25 points), mental disorders the second (score: 13.75), then fatigue (13 p), burnout and resilience (12p) and the less prioritary was motivation (7 points). The project was displayed in a canvas business model (figure 3) Image: Image 2: european Psychiatry S309